Abstract
BackgroundSevere malarial anaemia requiring blood transfusion is a life-threatening condition affecting millions of children in sub-Saharan Africa. Up to 40% of children with severe malarial anaemia have associated lactic acidosis. Lactic acidosis in these children is strongly associated with fatal outcomes and is corrected by blood transfusion. However, it is not known whether the storage age of blood for transfusion affects resolution of lactic acidosis. The objective of this pilot study was to evaluate the effect of blood storage age on resolution of lactic acidosis in children with severe malarial anaemia and demonstrate feasibility of conducting a large trial.MethodsChildren aged six to 59 months admitted to Acute Care Unit of Mulago Hospital (Kampala, Uganda) with severe malarial anaemia (haemoglobin ≤ 5 g/dL) and lactic acidosis (blood lactate ≥5 mmol/L), were randomly assigned to receive either blood of short storage age (one to 10 days) or long storage age (21–35 days) by gravity infusion. Seventy-four patients were enrolled and randomized to two equal-sized study arms. Physiological measurements, including blood lactate, oxygen saturation, haemoglobin, and vital signs, were taken at baseline, during and after transfusion. The primary outcome variable was the proportion of children whose lactic acidosis resolved by four hours after transfusion.ResultsThirty-four of 37 (92%) of the children in the short storage treatment arm compared to 30/37 (81%) in the long storage arm achieved a blood lactate <5 mmol/L by four hours post transfusion (p value = 0.308). The mean time to lactic acidosis resolution was 2.65 hours (95% CI; 2.25–3.05) in the short storage arm, compared to 3.35 hours (95% CI; 2.60–4.10) in the long storage arm (p value = 0.264).ConclusionPilot data suggest that among children with severe malarial anaemia and lactic acidosis transfused with packed red blood cells, the storage age of blood does not affect resolution of lactic acidosis. The results support a larger and well-powered study which is under way.Trial registrationclinicaltrials.gov NCT01580111
Highlights
Severe malarial anaemia requiring blood transfusion is a life-threatening condition affecting millions of children in sub-Saharan Africa
Duration of blood 50 (±5.9) transfusion. This pilot clinical trial was conducted to examine the feasibility of performing a larger study on the clinical effect of blood storage in profound malarial anaemia. The goal of this pilot study was to compare proportions of children aged six to 59 months with severe malarial anaemia that resolved lactic acidosis (LA) by fours following the start of transfusion with packed red blood cells (RBCs) of long storage (21–35 days) versus short storage age
These results suggest that in the treatment of severe malarial anaemia (SMA) complicated with LA, the storage age of blood for transfusion does not affect LA resolution
Summary
Severe malarial anaemia requiring blood transfusion is a life-threatening condition affecting millions of children in sub-Saharan Africa. Up to 40% of children with severe malarial anaemia have associated lactic acidosis. Lactic acidosis in these children is strongly associated with fatal outcomes and is corrected by blood transfusion. Severe malarial anaemia requiring blood transfusion remains a major health issue in sub-Saharan Africa [1]. It is the commonest defining manifestation of severe malaria among children at Acute Care Unit (ACU) of Mulago Hospital (Kampala, Uganda), occurring in 39.4% of children with malaria [2]. LA is more pronounced in severe malarial anaemia compared with severe nonmalarial anaemia and case fatality rates may be up to twice as high (9% vs 4%) in malaria for the same level of anaemia [5]
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